Vaccinations in patients diagnosed with an autoimmune disorder receiving an immunosuppressive agent: a best practice implementation project

Abstract

ABSTRACT Introduction: Immunosuppressed patients face increased health risks due to infections such as influenza or COVID-19. Scientific evidence supports improved health-related outcomes in this patient population, such as reduced hospitalizations, with up-to-date vaccinations. The project setting, a community-based rheumatology clinic, did not have a vaccination record specific to the needs of immunosuppressed patients, which may have led to suboptimal immunization status in these patients. Objective: This project aimed to promote evidence-based practices regarding the use of vaccinations in patients diagnosed with autoimmune disorders receiving immunosuppressive agents. Methods: This project used the JBI evidence implementation framework to promote best practices regarding vaccination. Two audit criteria were identified using a JBI evidence summary. Baseline audits identified gaps between the evidence and current practice. Barriers to best practice were then identified, and strategies implemented. Post-implementation audits measured changes in compliance. Results: Baseline audits revealed 67% compliance with the two best practices. Barriers included a lack of provider awareness of the current vaccination recommendations for immunosuppressed patients and a lack of customizable vaccine records. Strategies to address these barriers included educating providers about current national vaccination recommendations and implementing a new patient vaccination history intake form. Post-implementation audits revealed 83% compliance, a 16% increase from baseline. Conclusions: This evidence-based implementation project enhanced best practices by educating providers and implementing an updated patient vaccination history form. Recommendations included improved compliance with the use of the new form and assessing the effectiveness and usability of a customizable electronic form that interfaced with the clinic's electronic medical records.